Meldonium, sold under the brand name Mildronate, is a performance-enhancing drug that is the source of much debate in the world of sports doping.

Initially designed in Latvia for use in animals, the World Anti-Doping Agency (WADA) has indicated that this drug is banned in Olympic sports.

Meldonium is primarily manufactured by a Latvian drug company called Grindeks. It is also known as Mildronāts, Quaterine, MET-88, THP, trimethylhydrazinium propionate, and 3-(2,2,2-trimethylhydraziniumyl)propionate,

It is licensed throughout Eastern Europe and Central Asia for a number of conditions, including cardiac complaints. Meldonium is not licensed for use in the United States.

Meldonium remains on the WADA’s list of banned drugs in sports.

A number of athletes from the United States, Russia, and Europe are currently facing bans for using meldonium. Most recently, this includes Alexander Krushelnitsky, who won medals in curling for Russia at the most recent Winter Olympics. The Olympic committee stripped him of his medals and banned him from participation in his sport for 2 years.

In this article, we will look at the origins of meldonium, its possible medical uses, and associated research and news.

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Meldonium has caused controversy due to its involved in sports doping scandals.

Meldonium is a drug that enhances athletic performance.

One of the early uses of meldonium was in animals. Agricultural workers used the drug specifically to enhance the sexual performance and sperm motility of boars. Its license was later expanded for use in humans.

The pharmaceutical company Grendiks, based in Latvia, produced meldonium. With sales of the drug reaching 56 million euros in 2013, it is one of Latvia’s biggest medical exports.

According to the designer of the drug, Ivar Kalvins, chair of the scientific board of the Latvian Institute of Organic Synthesis, meldonium was created to increase the capacity of the body to carry oxygen.

Prior to the use of meldonium for cardiac health issues, the company shipped large quantities of the drug to Soviet troops in Afghanistan between 1979 and 1989.

Due to the mountainous terrain of Afghanistan, Soviet soldiers would take meldonium to increase their endurance in the oxygen-reduced air while carrying large backpacks.

Meldonium is a fatty acid oxidation inhibitor, and it is now principally used for heart conditions, such as angina, heart attack, heart failure, and others. The medication works by altering pathways for carnitine, a nutrient involved in fat metabolism.

A study in 2005 found that meldonium, in combination with an angiotensin-converting enzyme inhibitor called lisinopril, improved exercise capability and peripheral circulation for individuals with chronic heart failure.

A Chinese study group tested meldonium for its efficacy in treating acute ischemic stroke, finding it to be as effective as cinepazide, a vasodilator that people in China commonly use to treat stroke.

In some countries, people use meldonium to treat problems with circulation in the brain. Some people report that the drug elevates mood and improves motor symptoms, dizziness, and nausea.

These countries include:

  • Latvia
  • Russia
  • Ukraine
  • Georgia
  • Kazakhstan
  • Azerbaijan
  • Belarus
  • Uzbekistan
  • Moldova
  • Kyrgyzstan

Meldonium might also help reduce withdrawal symptoms in people with alcohol dependency.

Other possible uses for meldonium include:

  • immune system modulation
  • treating stomach ulcers
  • treating eye trauma
  • treating infections of the lungs and upper respiratory tract

WADA added meldonium to their list of banned substances in 2016 because of “evidence of its use by athletes with the intention of enhancing performance.”

They class meldonium as a metabolic modulator in the same bracket as insulin.

A study published in Drug Testing and Analysis in December 2015 summarized the following about meldonium:

[It] demonstrates an increase in endurance performance of athletes, improved rehabilitation after exercise, protection against stress, and enhanced activations of central nervous system (CNS) functions.”

Meldonium hit the headlines in 2016 as a result of the former world number-one tennis player, Maria Sharapova.

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Maria Sharapova faced a ban after testing positive for meldonium.
Image credit: [http://www.flickr.com/photos/david_wilmot/ daramot], 2006.

She tested positive for the substance on March 7, 2016. Although Ms. Sharapova contested that she had been taking meldonium for 10 years to treat an on-going medical issue, she received a provisional suspension.

Since then, more sportspeople from Russia, Ethiopia, Sweden, Germany, and Ukraine have received provisional bans after positive tests for meldonium.

However, on April 13, 2016, WADA advised they would be able to overturn the bans of any athletes who tested positive before March 1, 2016. This is because the governing body does not yet have reliable data on how long the body takes to excrete meldonium, and so it was unclear whether athletes facing accusations of doping took the drug after it became illegal.

Most recently, the Russian team experienced controversy after receiving a ban from the Pyongyang Winter Olympics for widespread doping allegations.

While some members of the team still had permission to compete without any connection to the country, it showed how seriously WADA take the use of meldonium in competitive sports.